Morris J C
Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
Int Psychogeriatr. 1997;9 Suppl 1:173-6; discussion 177-8. doi: 10.1017/s1041610297004870.
Global staging measures for dementia of the Alzheimer type (DAT) assess the influence of cognitive loss on the ability to conduct everyday activities and represent the "ultimate test" of efficacy for antidementia drug trials. They provide information about clinically meaningful function and behavior and are less affected by the "floor" and "ceiling" effects commonly associated with psychometric tests. The Washington University Clinical Dementia Rating (CDR) is a global scale developed to clinically denote the presence of DAT and stage its severity. The clinical protocol incorporates semistructured interviews with the patient and informant to obtain information necessary to rate the subject's cognitive performance in six domains: memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care. The CDR has been standardized for multicenter use, including the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) and the Alzheimer's Disease Cooperative Study, and interrater reliability has been established. Criterion validity for both the global CDR and scores on individual domains has been demonstrated, and the CDR also has been validated neuropathologically, particularly for the presence or absence of dementia. Standardized training protocols are available. Although not well suited as a brief screening tool for population surveys of dementia because the protocol depends on sufficient time to conduct interviews, the CDR has become widely accepted in the clinical setting as a reliable and valid global assessment measure for DAT.
阿尔茨海默病型痴呆（DAT）的整体分期措施评估认知功能丧失对日常活动能力的影响，代表了抗痴呆药物试验疗效的“最终测试”。它们提供了有关具有临床意义的功能和行为的信息，并且较少受到通常与心理测量测试相关的“地板效应”和“天花板效应”的影响。华盛顿大学临床痴呆评定量表（CDR）是一种整体量表，旨在临床上表明DAT的存在并对其严重程度进行分期。临床方案包括对患者和知情者进行半结构化访谈，以获取对受试者在六个领域的认知表现进行评分所需的信息：记忆、定向、判断和解决问题、社区事务、家庭和爱好以及个人护理。CDR已针对多中心使用进行了标准化，包括阿尔茨海默病注册协会（CERAD）和阿尔茨海默病合作研究，并且已经建立了评分者间的可靠性。已证明整体CDR和各个领域得分的标准效度，并且CDR在神经病理学上也已得到验证，特别是对于痴呆的存在与否。有标准化的培训方案。尽管由于该方案依赖于足够的时间进行访谈，不太适合作为痴呆人群调查的简短筛查工具，但CDR在临床环境中已被广泛接受，作为DAT的可靠且有效的整体评估措施。
